Health and Care Bill

Lord Mackay of Clashfern Excerpts

Lords Hansard - Part 2 & Committee stage
Tuesday 18th January 2022 Lords Chamber

Against that background, I hope that I have said enough to persuade my noble friend to move her amendment when the time comes for it to be called and to persuade the noble Lords, Lord Hunt and Lord Clement-Jones, not to press theirs.

[Lord Mackay of Clashfern (Con)]

My Lords, the Minister is much in agreement with others that the leadership being enthusiastic for progress is important. I understand that nominations have already been made for the various positions that are likely to come up. To what extent has enthusiasm for digital transformation been a criterion in nominating those people? It is vital that the leader really believes in what is to happen if it is to happen at all. Therefore, it would be useful to know to what extent that consideration has applied in the prospective nominations of people for the local positions.

[Earl Howe (Con)]

Noble Lords will remember that, even 10 years ago, when I was appointed as a Health Minister, there was an acronym, QIPP, which stood for “quality, innovation, productivity and prevention”. While I think the acronym has largely fallen out of use, those four principles remain alive and kicking in the strategic thinking that happens at the top of the health service, and indeed in the department.

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I remember that, back in the dim distant days when I was director of the association, and even when I was a community health council member 10 years earlier than that, 45 years ago, it was often the local community health council representative sitting there at meetings with the professionals and managers, all of whom speak their own language, which is rather different from that of the patients. They were being told things about the way in which the local service was operating and being delivered at the local level, which they would not have heard otherwise. That is why, at the centre of our deliberations, at both local and national level, the patient voice must be heard and properly supported and resourced.

[Lord Mackay of Clashfern (Con)]

My Lords, I strongly support that. It seems to me that the National Health Service is devoted to looking after patients. Therefore, it is very strange that there is no national voice for patients to speak to it. In a way, Healthwatch England fulfils that—but in a very awkward position.

I do not know exactly the relationship within the constitution of the committee and the CQC. For example, it may be important that knowledge that Healthwatch has goes to the CQC, but it must be much better for it to be independent at every level, national and local, and to not take part in any of the particular arrangements but rather independently give the pure voice of the patients, which it has received, as it were, from the people who have been served by the National Health Service, whether that is complimentary or otherwise, according to what has actually happened. That seems to me to be essential. I cannot think that it is effective to have a National Health Service with no voice to be heard at the centre from the patients.

[Baroness Walmsley (LD)]

My Lords, I quite often buy things online and, a few days after the product has arrived, I often get an email saying, “How did we do? Give us one, two, three, four or five stars.” That can be very irritating, and I suspect that, on the whole, people do not respond, unless the service has either been dreadful or brilliant—that is certainly so in my case. The voice of the patient is far more important than that and, if we are to assess the performance of different ICSs, the voice of the patient is absolutely fundamental to gathering the evidence, using which we can compare their performance.

A few years ago, I had to be in hospital, just for a few days. At the end of my treatment, when I was about to go home, I was handed a little slip of paper. I do not know if they still do this, but it had some kind of snappy title like, “Tell us how we did”. I thought it was totally inadequate, because here was I, as a patient, having had a general anaesthetic, feeling a bit wobbly, but crucially, having had only the experience of that particular treatment in that particular hospital. The beauty of Healthwatch is that it can compare the experience of patients, heard directly from those patients, of a lot of different treatments in different settings. It can bring together the voice of the patient and—absolutely crucially—it has the ear of the people who deliver those services and can authoritatively explain to them where they are doing well and where they are doing badly.

In this group of amendments, the noble Lord, Lord Hunt, and others have got it right in their suggestions about the level at which Healthwatch should have a voice: non-voting membership of the ICB, voting membership of the ICP and, crucially, independence from the CQC. The noble Lord, Lord Harris, put it very well: how on earth could Healthwatch criticise the CQC as the regulator if it is part of it? It is a little bit like asking a civil servant to criticise the Prime Minister, is it not? The noble Lord, Lord Hunt, and others who have spoken have got the level right at which Healthwatch should play its part in this great new world of integrated services. The view of the patient of the experience that they received at the hands of all the health and care services is absolutely crucial to being able to compare the performance of these bodies that we are setting up.